1
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Cave DG, Bautista MJ, Mustafa K, Bentham JR. Cardiac output monitoring in children: a review. Arch Dis Child 2023; 108:949-955. [PMID: 36927620 DOI: 10.1136/archdischild-2022-325030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
Cardiac output monitoring enables physiology-directed management of critically ill children and aids in the early detection of clinical deterioration. Multiple invasive techniques have been developed and have demonstrated ability to improve clinical outcomes. However, all require invasive arterial or venous catheters, with associated risks of infection, thrombosis and vascular injury. Non-invasive monitoring of cardiac output and fluid responsiveness in infants and children is an active area of interest and several proven techniques are available. Novel non-invasive cardiac output monitors offer a promising alternative to echocardiography and have proven their ability to influence clinical practice. Assessment of perfusion remains a challenge; however, technologies such as near-infrared spectroscopy and photoplethysmography may prove valuable clinical adjuncts in the future.
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Affiliation(s)
- Daniel Gw Cave
- Leeds Congenital Heart Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, West Yorkshire, UK
| | - Melissa J Bautista
- General Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
- General Surgery, University of Leeds, Leeds, West Yorkshire, UK
| | - Khurram Mustafa
- Paediatric Intensive Care, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James R Bentham
- Leeds Congenital Heart Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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Li M, Wang S, Zhang H, Zhang H, Wu Y, Meng B. The predictive value of pressure recording analytical method for the duration of mechanical ventilation in children undergoing cardiac surgery with an XGBoost-based machine learning model. Front Cardiovasc Med 2022; 9:1036340. [PMID: 36386354 PMCID: PMC9649993 DOI: 10.3389/fcvm.2022.1036340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022] Open
Abstract
Objective Prolonged mechanical ventilation in children undergoing cardiac surgery is related to the decrease in cardiac output. The pressure recording analytical method (PRAM) is a minimally invasive system for continuous hemodynamic monitoring. To evaluate the postoperative prognosis, our study explored the predictive value of hemodynamic management for the duration of mechanical ventilation (DMV). Methods This retrospective study included 60 infants who underwent cardiac surgery. Cardiac index (CI), the maximal slope of systolic upstroke (dp/dtmax), and cardiac cycle efficiency (CCE) derived from PRAM were documented in each patient 0, 4, 8, and 12 h (T0, T1, T2, T3, and T4, respectively) after their admission to the intensive care unit (ICU). A linear mixed model was used to deal with the hemodynamic data. Correlation analysis, receiver operating characteristic (ROC), and a XGBoost machine learning model were used to find the key factors for prediction. Results Linear mixed model revealed time and group effect in CI and dp/dtmax. Prolonged DMV also have negative correlations with age, weight, CI at and dp/dtmax at T2. dp/dtmax outweighing CI was the strongest predictor (AUC of ROC: 0.978 vs. 0.811, p < 0.01). The machine learning model suggested that dp/dtmax at T2 ≤ 1.049 or < 1.049 in combination with CI at T0 ≤ 2.0 or >2.0 can predict whether prolonged DMV (AUC of ROC = 0.856). Conclusion Cardiac dysfunction is associated with a prolonged DMV with hemodynamic evidence. CI measured by PRAM immediately after ICU admission and dp/dtmax 8h later are two key factors in predicting prolonged DMV.
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3
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Zhang D, Ouyang C, Zhao X, Cui B, Dai F, Meng L, Ma J. Renal tissue desaturation and acute kidney injury in infant cardiac surgery: a prospective propensity score-matched cohort study. Br J Anaesth 2021; 127:620-628. [PMID: 34446224 DOI: 10.1016/j.bja.2021.06.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/30/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous studies on the association between renal tissue desaturation and acute kidney injury (AKI) in infant cardiac surgery are limited by small sample sizes and inconsistent results. This prospective study aimed to determine the association between renal desaturation and AKI in infants undergoing surgical repair of an isolated ventricular septal defect (VSD). METHODS Infants undergoing VSD repair involving cardiopulmonary bypass participated in this prospective cohort study. The exposure of interest was renal tissue desaturation, defined as at least 20% decrease in saturation from baseline for at least 60 consecutive seconds. Intraoperative care was not guided by renal oxygenation, as the anaesthesiologists were blinded to the monitor. The outcome was AKI arising within postoperative Days 1-3. The primary analysis was based on propensity score-matched infants with and without intraoperative renal desaturation. RESULTS Intraoperative renal desaturation was detected in 38 of 242 infants using near-infrared spectroscopy. This group of infants was matched with 114 infants without intraoperative renal saturation after propensity score matching. Acute kidney injury occurred in 47% (18/38) and 27% (31/114) of infants with or without renal desaturation, respectively. Infants with renal desaturation had higher odds of developing AKI than infants without renal desaturation based on conditional logistic regression (odds ratio 2.79; 95% confidence interval: 1.21-6.44; P=0.016). The cumulative time of renal desaturation correlated moderately with the ratio of postoperative peak creatinine to preoperative baseline creatinine (r=0.51; P<0.001). CONCLUSIONS Intraoperative renal desaturation is associated with increased odds of developing AKI after surgical repair of an isolated VSD involving cardiopulmonary bypass in infants. CLINICAL TRIAL REGISTRATION NCT03941015.
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Affiliation(s)
- Dongni Zhang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chuan Ouyang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Zhao
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Boqun Cui
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Feng Dai
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Lingzhong Meng
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
| | - Jun Ma
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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4
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Dell'Era G, Gravellone M, Scacchi S, Franzone PC, Pavarino LF, Boggio E, Prenna E, De Vecchi F, Occhetta E, Devecchi C, Patti G. A clinical-in silico study on the effectiveness of multipoint bicathodic and cathodic-anodal pacing in cardiac resynchronization therapy. Comput Biol Med 2021; 136:104661. [PMID: 34332350 DOI: 10.1016/j.compbiomed.2021.104661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
Up to one-third of patients undergoing cardiac resynchronization therapy (CRT) are nonresponders. Multipoint bicathodic and cathodic-anodal left ventricle (LV) stimulations could overcome this clinical challenge, but their effectiveness remains controversial. Here we evaluate the performance of such stimulations through both in vivo and in silico experiments, the latter based on computer electromechanical modeling. Seven patients, all candidates for CRT, received a quadripolar LV lead. Four stimulations were tested: right ventricular (RVS); conventional single point biventricular (S-BS); multipoint biventricular bicathodic (CC-BS) and multipoint biventricular cathodic-anodal (CA-BS). The following parameters were processed: QRS duration; maximal time derivative of arterial pressure (dPdtmax); systolic arterial pressure (Psys); and stroke volume (SV). Echocardiographic data of each patient were then obtained to create an LV geometric model. Numerical simulations were based on a strongly coupled Bidomain electromechanical coupling model. Considering the in vivo parameters, when comparing S-BS to RVS, there was no significant decrease in SV (from 45 ± 11 to 44 ± 20 ml) and 6% and 4% increases of dPdtmax and Psys, respectively. Focusing on in silico parameters, with respect to RVS, S-BS exhibited a significant increase of SV, dPdtmax and Psys. Neither the in vivo nor in silico results showed any significant hemodynamic and electrical difference among S-BS, CC-BS and CA-BS configurations. These results show that CC-BS and CA-BS yield a comparable CRT performance, but they do not always yield improvement in terms of hemodynamic parameters with respect to S-BS. The computational results confirmed the in vivo observations, thus providing theoretical support to the clinical experiments.
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Affiliation(s)
- G Dell'Era
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | - M Gravellone
- Divisione di Cardiologia, Ospedale Degli Infermi, Biella, Italy
| | - S Scacchi
- Dipartimento di Matematica, Università Degli Studi di Milano, Via Saldini 50, 20133, Milano, Italy.
| | - P Colli Franzone
- Dipartimento di Matematica, Università Degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - L F Pavarino
- Dipartimento di Matematica, Università Degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - E Boggio
- Divisione di Cardiologia, Ospedale Degli Infermi, Biella, Italy
| | - E Prenna
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy
| | - F De Vecchi
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - E Occhetta
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - C Devecchi
- Divisione di Cardiologia, Ospedale Sant'Andrea, Vercelli, Italy
| | - G Patti
- Cardiologia 1, Azienda Ospedaliera Universitaria "Maggiore Della Carità", Novara, Italy; Dipartimento di Medicina Traslazionale, Università Del Piemonte Orientale, Novara, Italy
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5
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Lou X, Liu Y, Cui Y, Li J, Li L, Ma L, Zou M, Chen X, Li J. Contemporary Trends and Risk Factors of Hemodynamic and Myocardial Mechanics Derived by the Pressure Recording Analytical Method After Pediatric Cardiopulmonary Bypass. Front Cardiovasc Med 2021; 8:687150. [PMID: 34355027 PMCID: PMC8330813 DOI: 10.3389/fcvm.2021.687150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/25/2021] [Indexed: 01/14/2023] Open
Abstract
Objective: Adverse factors of postoperative hemodynamic and myocardial performance remain largely unexplored in children with congenital heart disease following cardiopulmonary bypass due to technical limitations. Pressure recording analytical method (PRAM) is a continuous hemodynamic and myocardial performance monitoring technique based on beat-to-beat arterial pressure waveform. Using PRAM, we examined the temporal trends and adverse factors, in clinical management, of these performances. Methods: We monitored blood pressure, cardiac index, cardiac cycle efficiency (CCE), dP/dTmax, and systematic vascular resistance index in 91 children (aged 186 ± 256 days) during their first 48 h after cardiopulmonary bypass. Above parameters, inotropic and vasoactive drug dosages, and serum lactate were recorded 3-hourly. NT-proBNP was measured daily. Results: CCE and dP/dTmax gradually increased (Ps < 0.0001), while systematic vascular resistance index, diastolic blood pressure and inotrope dosages decreased (Ps < 0.0001) over time. Cardiac index, systolic blood pressure, and heart rate did not change significantly (Ps ≥ 0.231). Patients undergoing deep hypothermic circulatory arrest had significantly higher heart rate and lower CCE (Ps ≤ 0.006) over time. Multivariate analyses indicated that epinephrine dose significantly correlated with systolic blood pressure, cardiac index, CCE, and dP/dTmax after polynomial transformation, with the peak ranging from 0.075 to 0.097. Conclusions: Systemic hemodynamic and myocardial performance gradually improved in the first 48 h after cardiopulmonary bypass without the “classic” nadir at 9–12 h. Deep hypothermic circulatory arrest and higher epinephrine doses were adversely associated with these performances. CCE, rather than cardiac index or other common-used parameters, was the most sensitive and consistent indicator.
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Affiliation(s)
- Xiaobin Lou
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yingying Liu
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqin Cui
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jianbin Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lijuan Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Ma
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiovascular Surgery, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Minghui Zou
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiovascular Surgery, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xinxin Chen
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Cardiovascular Surgery, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jia Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Cardiac Output Evaluation on Septic Shock Patients: Comparison between Calibrated and Uncalibrated Devices during Vasopressor Therapy. J Clin Med 2021; 10:jcm10020213. [PMID: 33435270 PMCID: PMC7826755 DOI: 10.3390/jcm10020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
There are no reliable, non-invasive methods to accurately measure cardiac output (CO) in septic patients. MostCare (Vytech Health™, Vygon, Padova, Italy), is a beat-to-beat, self calibrated method for CO measurement based on continuous analysis of reflected arterial pressure waveforms. We enrolled 40 patients that were suffering from septic shock and requiring norepinephrine infusion to target blood pressure in order to to evaluate the level of agreement between a calibrated transpulmonary thermodilution device (PiCCO System, Pulsion Medical Systems, Feldkirchen, Germany) and the MostCare system in detecting and tracking changes in CO measurements related to norepinephrine reduction in septic shock patients,. PiCCO was connected to a 5 Fr femoral artery catheter and to a central venous catheter. System calibration was performed with 15 mL of cold saline injection over about 3 s. The MostCare device was connected to the artery catheter to analyze the arterial waveform. Before reducing norepinephrine infusion, the PiCCO system was calibrated, the MostCare waveform was optimized, and the values of the complete hemodynamic profile were recorded (T1). Norepinephrine infusion was then reduced by 0.03 mcg/Kg/min. After 30 min, a new calibration of PiCCO system and a new record on both monitors were performed (T2). Static measurements agreements were assessed using the Bland-Altman test, while trending ability was investigated using polar plot analysis. If volume expansion occurred, then related data were separately analyzed. At T1 mean the CO was 5.38 (SD 0.60) L/min, the mean difference was 0.176 L/min, the limits of agreement (LoA) was +1.39 and -1.04 L/min, and the percentage error (PE) was 22.6%; at T2 the mean CO was 5.44 (SD 0.73) L/min, the mean difference was 0.053 L/min, the LoA was +1.51 and -1.40, and the PE was 27%. After considering the volume expansion between T1 and T2, the mean CO at T1 was 5.39 L/min (SD 0.47), the LoA was +1.09 and -0.78 L/min, and the percentage error (PE) was 17%; at T2 the mean CO was 5.35 L/min (SD 0.81), the LoA was +1.73 and -1.52 L/min, and the PE was 30%. The polar plot diagram seems to confirm the trending ability of MostCare system versus the reference method. In septic patients, when the arterial waveform is accurate, MostCare and PiCCO transpulmonary thermodilution exhibit good agreement even after the reduction of norepinephrine and changes in vascular tone or volume expansion. MostCare could be a rapid to set, reliable, and useful tool to monitor hemodynamic variations in septic patients in emergency contexts where thermodilution methods or other advanced systems are not easily available.
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7
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Prediction of Fluid Responsiveness by Stroke Volume Variation in Children Undergoing Fontan Operation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2595960. [PMID: 33224977 PMCID: PMC7669329 DOI: 10.1155/2020/2595960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022]
Abstract
Background Fontan operation is a palliative medical procedure performed on children with single-ventricle defects. As postoperative success of the procedure largely depends on the preload volume, it is necessary to maintain an appropriate pressure gradient between the systemic vein and the left atrium to ensure the effective volume of systemic circulation. However, there is a lack of effective indexes to evaluate fluid responsiveness in Fontan patients. Stroke volume variation (SVV) is a dynamic hemodynamic parameter based on cardiopulmonary interaction in mechanical ventilation. This study is aimed at validating the sensitivity and specificity of SVV and central venous pressure (CVP) in assessing the fluid responsiveness of Fontan patients. Method Sixty-four children with single ventricle who underwent modified Fontan operation between May 2018 and January 2020 were included in this study. Patients were administered 10 ml·kg−1 albumin for fluid challenge within 10 min after cardiopulmonary bypass. Before and after fluid challenge, the invasive arterial pressure module was connected to MostCare™ equipment to collect the cardiac index (CI) and SVV dynamically in a time window of 30 s at a frequency of 1000 Hz. According to the range of CI change, patients with ΔCI ≥ 15% were classified into the responder (R) group and those with ΔCI < 15% into the nonresponder (NR) group. Using SVV and CVP as indicators, the receiver operating characteristic (ROC) curve of the patients was established, and the area under curve (AUC), diagnostic threshold, sensitivity, and specificity were calculated. Results The SVV values were 16.28% (25th and 75th percentiles 14.17%-19.24%) and 13.68% (25th and 75th percentiles 12.90%-15.89%) before and after fluid challenge treatment in responders, respectively, and the values were 18.60 ± 1.83 mmHg before and 20.20 ± 2.39 mmHg for CVP after treatment. The AUC of SVV was 0.74 (95% confidence interval (CI) 0.54-0.94, P < 0.05), and the cutoff value was 16%, offering a sensitivity of 50% and a specificity of 91.7%. Meanwhile, the AUC of CVP was 0.70 (95% CI 0.50-0.92, P > 0.05), and the cutoff value was 19.5 mmHg, offering a sensitivity of 58% and a specificity of 76%. Conclusion SVV exhibited a good predictive value for fluid responsiveness in pediatric Fontan patients. Appropriate fluid therapy according to SVV could improve the cardiac function of such patients. Trial registration. This study was registered in Chinese Clinical Trail Registry on Jan 26, 2018. Registration number is ChiCTR1800014654. Registry URL is http://www.chictr.org.cn/showproj.aspx?proj=25019. This observational prospective study was approved by the Local Ethics Committee of Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University (SCMCIRB-K2017035).
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8
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Abstract
Clinical assessment of cardiac output by interpretation of indirect parameters has proven to be inaccurate, irrespective of the level of experience of the clinician. Objective cardiac output monitoring is feasible in newborn infants in intensive care. The most promising methods include transthoracic echocardiography, transcutaneous Doppler, electrical biosensing technologies, transpulmonary ultrasound dilution, and arterial pulse contour analysis. Simultaneous assessment of blood pressure and cardiac output enables the identification of the earliest stage of shock. Comprehensive hemodynamic monitoring is pivotal for an individualized pathophysiology-based hemodynamic management.
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Affiliation(s)
- Willem-Pieter de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, PO Box 9101, Nijmegen 6500 HB, The Netherlands.
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9
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Han D, Pan S, Li H, Meng L, Luo Y, Ou-Yang C. Prognostic value of cardiac cycle efficiency in children undergoing cardiac surgery: a prospective observational study. Br J Anaesth 2020; 125:321-329. [PMID: 32636084 DOI: 10.1016/j.bja.2020.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac cycle efficiency (CCE) derived from a pressure-recording analytical method is a unique parameter to assess haemodynamic performance from an energetic view. This study investigated changes of CCE according to an anatomical diagnosis group, and its association with early postoperative outcomes in children undergoing cardiac surgery. METHODS Ninety children were included with a ventricular septal defect (VSD; n=30), tetralogy of Fallot (TOF; n=40), or total anomalous pulmonary venous connection (TAPVC; n=20). CCE along with other haemodynamic parameters, was recorded from anaesthesia induction until 48 h post-surgery. Predictive CCE (CCEp) was defined as the average of CCE at post-modified ultrafiltration and CCE at the end of surgery. The relationship between CCE and early outcomes was assessed by the comparison between the high-CCEp group (CCEp ≥75th centile) and the low-CCEp group (CCEp ≤25th centile). RESULTS There was a significant time × diagnostic group interaction effect in the trend of CCE. Compared with the high-CCEp group (n=23), the low-CCEp group (n=22) required more inotropics post-surgery, had higher lactate concentrations at 8 and 24 h post-surgery, a longer intubation time and longer ICU stay, and higher frequency of peritoneal fluid. CONCLUSIONS Perioperative changes of CCE vary according to anatomical diagnosis in children undergoing cardiac surgery. Children with TOF have an unfavourable trend of CCE compared with children with VSD or TAPVC. A decline in CCE is associated with adverse early postoperative outcomes. CLINICAL TRIAL REGISTRATION ChiCTR1800014996.
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Affiliation(s)
- Ding Han
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Shoudong Pan
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Hang Li
- Clinical Medicine, North China University of Science and Technology, Hebei, China
| | - Linghui Meng
- Department of Evidence based Medicine, Capital Institute of Paediatrics, Beijing, China
| | - Yi Luo
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Chuan Ou-Yang
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China; Anaesthesia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Han D, Li H, Pan S, Xie S, Deryck Y, Luo Y, Li J, Ou-Yang C. Measuring Cerebral Carbon Dioxide Reactivity With Transcranial Doppler and Near-Infrared Spectroscopy in Children With Ventricular Septal Defect. J Cardiothorac Vasc Anesth 2020; 34:344-348. [DOI: 10.1053/j.jvca.2019.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/22/2019] [Accepted: 06/26/2019] [Indexed: 11/11/2022]
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11
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Han D, Pan S, Ouyang C. Pulse Pressure Variation Is Affected by P ETCO 2 in Children with Intracardiac Left-to-Right Shunt. J Cardiothorac Vasc Anesth 2019; 33:2883-2884. [PMID: 31138464 DOI: 10.1053/j.jvca.2019.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Ding Han
- Department of Anesthesiology, Capital Institute of Pediatrics, Beijing, China
| | - Shoudong Pan
- Department of Anesthesiology, Capital Institute of Pediatrics, Beijing, China
| | - Chuan Ouyang
- Department of Anesthesiology, Beijing Anzhen Hospital, Beijing, China
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12
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Pittarello D, Vida V, Di Gregorio G, Falasco G, Stellin G, Ori C. Comparison between Pressure Recording Analytical Method and Fick Method to Measure Cardiac Output in Pediatric Cardiac Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.2174/2589645801812010008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background:
There is an increased interest in methods of objective cardiac output measurement in pediatric cardiac surgery. Several techniques are available, but have limitations, among the new technologies pressure recording analytical method with MostCare (MostCare-PRAM), a minimally invasive hemodynamic monitoring system, represents a novel arterial pulse contour method that does not require calibration. For this reason, we compared the MostCare-PRAM vs the Fick method for estimation of cardiac output.
Methods:
We studied prospectively 13 pediatric patients who underwent cardiac surgery and compared intraoperatively Cardiac Index (CI) measured with the MostCare-PRAM with the CI measured with the Fick method. We also measured Cardiac Cycle Efficiency (CCE) and maximal arterial pressure/time ratio (dp/dt max) and compared with Fick method.
Results:
The data showed good agreement between CI Fick and CI MostCare-PRAM (r = 0.93 and R2= 0.86; p < 0.0001) and also between CCE (r = 0.82 and R2 = 0.67; p < 0.001) and dp/dt (r = 0.84; R2 = 0.81; p < 0.001) with CI measured with Fick method.
Conclusion:
In pediatric patients submitted to cardiac surgery, the MostCare-PRAM seems to estimate CI with a good level of agreement with the Fick method measurements.
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13
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Han D, Liu YG, Pan S, Luo Y, Li J, Ou-Yang C. Comparison of hemodynamic effects of sevoflurane and ketamine as basal anesthesia by a new and direct monitoring during induction in children with ventricular septal defect: A prospective, randomized research. Medicine (Baltimore) 2017; 96:e9039. [PMID: 29390298 PMCID: PMC5815710 DOI: 10.1097/md.0000000000009039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sevoflurane and ketamine are commonly used to obtain sedation and facilitate intravenous anesthetic induction in children undergoing cardiac surgery who are uncooperative. We used a new and direct systemic hemodynamic monitoring technique pressure recording analytical method and compared the hemodynamic effects of sevoflurane and ketamine to facilitate intravenous anesthetic induction. METHODS Forty-four children with ventricular septal defect (2.2 ± 1.2 years) were enrolled and randomized to receive sevoflurane (Group S) or intramuscular ketamine (Group K) for sedation, followed by intravenous midazolam-sufentanil induction and tracheal intubation. Recorded parameters included heart rate (HR), arterial pressures, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) after sedation obtained with sevoflurane or ketamine, 1, 2, 5 minutes after midazolam-sufentanil, 1, 2, 5, and 10 minutes after tracheal intubation. Rate-pressure product (RPP) and cardiac power output (CPO) were calculated. RESULTS As compared with Group S, Group K had faster decreases during intravenous anesthetic induction in arterial pressures (P < .01 for all), higher HR, arterial pressures, SVRI, dp/dtmax, RPP, lower SVI, CI, CPO (P < .05 for all) during the study period. CONCLUSION As compared with sevoflurane, ketamine facilitated intravenous anesthetic induction exerts unfavorable effects on systemic hemodynamic and myocardial energetic in children with ventricular septal defect.
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Affiliation(s)
- Ding Han
- Anesthesia Department, Capital Institute of Pediatrics affiliated Children's Hospital
| | - Ya-Guang Liu
- Anesthesia Center, Capital Medical University affiliated Beijing Anzhen Hospital
| | - Shoudong Pan
- Anesthesia Department, Capital Institute of Pediatrics affiliated Children's Hospital
| | - Yi Luo
- Cardiac Surgery Division, Capital Institute of Pediatrics affiliated Children's Hospital
| | - Jia Li
- Clinical Physiology Laboratory, Capital Institute of Pediatrics, Beijing, China
| | - Chuan Ou-Yang
- Anesthesia Center, Capital Medical University affiliated Beijing Anzhen Hospital
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